Maternal gestational diabetes and different indicators of childhood obesity: a large study

Conducting a diabetes mellitus prevention trial in women with GDM in Pakistan: a feasibility study

BACKGROUND

Women with gestational diabetes mellitus (GDM) are at a greater risk of developing type 2 diabetes mellitus (T2DM) than women without GDM. Despite this elevated risk, few trials on the prevention of T2DM among South Asian women with GDM have been reported. Therefore, this study aimed to assess the feasibility of conducting a diabetes prevention program on women with a history of GDM to inform the development of a contextually relevant definitive trial.

METHODS

Using a randomized controlled trial, women with GDM (n = 180) who delivered at the study hospitals (one public and one private teaching hospital, Karachi) with fasting blood glucose levels < 120 mg/dl at 6 weeks postpartum were randomized to the intervention (n = 88) or control arms (n = 92). Women in the intervention group received individualized home-based educational sessions from trained community health workers at 0, 1, 3, 6, and 9 months. In addition, they received short text messages, prerecorded messages, and printed educational material (calendars and pamphlets) for reinforcement. The intervention was centered on equipping women with knowledge, skills, and confidence to eat a healthy diet rich in fruits, vegetables, and low-fat dairy products and perform regular physical activity based on walking and household chores to reduce weight (up to 5% of their initial body weight). Women in the control arm received standard care. The feasibility outcomes of the study included screening, recruitment, and retention rates and in-depth interviews at 6 months post-intervention to explore women's experiences with the intervention. Descriptive analysis and thematic analysis were performed.

RESULTS

Of the 324 women screened during the antenatal care visits and after delivery, 255 (78.7%) were contactable 6 weeks postpartum, and 180 (70.6%) were eligible and randomized to intervention (n = 88) and control (n = 92) groups. Loss to follow-up in the intervention and control arms was 22.7% (n = 20/88) and 18.5% (n = 17/92), respectively. Women expressed satisfaction with home-based counseling and follow-up visits, text message reminders, and printed material in the form of a calendar through our qualitative interviews.

CONCLUSIONS

Home-based lifestyle modification intervention augmented with text messages and printed material is feasible. However, to evaluate the intervention's effectiveness, a larger trial is warranted to assess its long-term impact on diabetes prevention.

TRIAL REGISTRATION

ISRCTN, ISRCTN11387113 . Registered 5 December 2017-retrospectively registered.

Maternal gestational diabetes and childhood adiposity risk from 6 to 8 years of age

BACKGROUND/OBJECTIVE

Previous studies found conflicting results on the association between maternal gestational diabetes mellitus (GDM) and childhood overweight/obesity. This study was to assess the association between maternal GDM and offspring's adiposity risk from 6 to 8 years of age.

METHODS

The present study longitudinally followed 1156 mother-child pairs (578 GDM and 578 non-GDM) at 5.9 ± 1.2 years postpartum and retained 912 mother-child pairs (486 GDM and 426 non-GDM) at 8.3 ± 1.6 years postpartum. Childhood body mass index (BMI), waist circumference, body fat and skinfold were measured using standardized methods.

RESULTS

Compared with the counterparts born to mothers with normal glucose during pregnancy, children born to mothers with GDM during pregnancy had higher mean values of adiposity indicators (waist circumference, body fat, subscapular skinfold and suprailiac skinfold) at 5.9 and 8.3 years of age. There was a positive association of maternal GDM with changes of childhood adiposity indicators from the 5.9-year to 8.3-year visit, and β values were significantly larger than zero: +0.10 (95% CI: 0.02-0.18) for z score of BMI for age, +1.46 (95% CI: 0.70-2.22) cm for waist circumference, +1.78% (95% CI: 1.16%-2.40%) for body fat, +2.40 (95% CI: 1.78-3.01) mm for triceps skinfold, +1.59 (95% CI: 1.10-2.09) mm for subscapular skinfold, and +2.03 (95% CI: 1.35-2.71) mm for suprailiac skinfold, respectively. Maternal GDM was associated with higher risks of childhood overweight/obesity, central obesity, and high body fat (Odd ratios 1.41-1.57 at 5.9 years of age and 1.73-2.03 at 8.3 years of age) compared with the children of mothers without GDM.

CONCLUSIONS

Maternal GDM was a risk factor of childhood overweight/obesity at both 5.9 and 8.3 years of age, which was independent from several important confounders including maternal pre-pregnancy BMI, gestational weight gain, children's birth weight and lifestyle factors. This significant and positive association became stronger with age.

Early ascending growth is associated with maternal lipoprotein profile during mid and late pregnancy and in cord blood

INTRODUCTION

Intrauterine conditions and accelerating early growth are associated with childhood obesity. It is unknown, whether fetal programming affects the early growth and could alterations in the maternal-fetal metabolome be the mediating mechanism. Therefore, we aimed to assess the associations between maternal and cord blood metabolite profile and offspring early growth.

METHODS

The RADIEL study recruited 724 women at high risk for gestational diabetes mellitus (GDM) BMI ≥ 30 kg/m2 and/or prior GDM) before or in early pregnancy. Blood samples were collected once in each trimester, and from cord. Metabolomics were analyzed by targeted nuclear magnetic resonance (NMR) technique. Following up on offsprings' first 2 years growth, we discovered 3 distinct growth profiles (ascending n = 80, intermediate n = 346, and descending n = 146) by using latent class mixed models (lcmm).

RESULTS

From the cohort of mother-child dyads with available growth profile data (n = 572), we have metabolomic data from 232 mothers from 1st trimester, 271 from 2nd trimester, 277 from 3rd trimester and 345 from cord blood. We have data on 220 metabolites in each trimester and 70 from cord blood. In each trimester of pregnancy, the mothers of the ascending group showed higher levels of VLDL and LDL particles, and lower levels of HDL particles (p < 0.05). When adjusted for gestational age, birth weight, sex, delivery mode, and maternal smoking, there was an association with ascending profile and 2nd trimester total cholesterol in HDL2, 3rd trimester total cholesterol in HDL2 and in HDL, VLDL size and ratio of triglycerides to phosphoglycerides (TG/PG ratio) in cord blood (p ≤ 0.002).

CONCLUSION

Ascending early growth was associated with lower maternal total cholesterol in HDL in 2nd and 3rd trimester, and higher VLDL size and more adverse TG/PG ratio in cord blood.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov, http://www.

CLINICALTRIALS

com , NCT01698385.

Functional data analysis with covariate-dependent mean and covariance structures

Functional data analysis has emerged as a powerful tool in response to the ever-increasing resources and efforts devoted to collecting information about response curves or anything that varies over a continuum. However, limited progress has been made with regard to linking the covariance structures of response curves to external covariates, as most functional models assume a common covariance structure. We propose a new functional regression model with covariate-dependent mean and covariance structures. Particularly, by allowing variances of random scores to be covariate-dependent, we identify eigenfunctions for each individual from the set of eigenfunctions that govern the variation patterns across all individuals, resulting in high interpretability and prediction power. We further propose a new penalized quasi-likelihood procedure that combines regularization and B-spline smoothing for model selection and estimation and establish the convergence rate and asymptotic normality of the proposed estimators. The utility of the developed method is demonstrated via simulations, as well as an analysis of the Avon Longitudinal Study of Parents and Children concerning parental effects on the growth curves of their offspring, which yields biologically interesting results.

Using the COM-B model and Behaviour Change Wheel to develop a theory and evidence-based intervention for women with gestational diabetes (IINDIAGO)

BACKGROUND

In South Africa, the prevalence of gestational diabetes (GDM) is growing, concomitant with the dramatically increasing prevalence of overweight/obesity among women. There is an urgent need to develop tailored interventions to support women with GDM to mitigate pregnancy risks and to prevent progression to type 2 diabetes post-partum. The IINDIAGO study aims to develop and evaluate an intervention for disadvantaged GDM women attending three large, public-sector hospitals for antenatal care in Cape Town and Soweto, SA. This paper offers a detailed description of the development of a theory-based behaviour change intervention, prior to its preliminary testing for feasibility and efficacy in the health system.

METHODS

The Behaviour Change Wheel (BCW) and the COM-B model of behaviour change were used to guide the development of the IINDIAGO intervention. This framework provides a systematic, step-by-step process, starting with a behavioural analysis of the problem and making a diagnosis of what needs to change, and then linking this to intervention functions and behaviour change techniques to bring about the desired result. Findings from primary formative research with women with GDM and healthcare providers were a key source of information for this process.

RESULTS

Key objectives of our planned intervention were 1) to address women's evident need for information and psychosocial support by positioning peer counsellors and a diabetes nurse in the GDM antenatal clinic, and 2) to offer accessible and convenient post-partum screening and counselling for sustained behaviour change among women with GDM by integrating follow-up into the routine immunisation programme at the Well Baby clinic. The peer counsellors and the diabetes nurse were trained in patient-centred, motivational counselling methods.

CONCLUSIONS

This paper offers a rich description and analysis of designing a complex intervention tailored to the challenging contexts of urban South Africa. The BCW was a valuable tool to use in designing our intervention and tailoring its content and format to our target population and local setting. It provided a robust and transparent theoretical foundation on which to develop our intervention, assisted us in making the hypothesised pathways for behaviour change explicit and enabled us to describe the intervention in standardised, precisely defined terms. Using such tools can contribute to improving rigour in the design of behavioural change interventions.

TRIAL REGISTRATION

First registered on 20/04/2018, Pan African Clinical Trials Registry (PACTR): PACTR201805003336174.

Myeloperoxidase G-463A and CYBA C242T genetic variants in gestational diabetes mellitus

Oxidative stress plays an important role in the pathophysiology of gestational diabetes mellitus (GDM). We investigated the relationship between NADPH oxidase p22phox subunit (CYBA) C242T (rs4673) and myeloperoxidase (MPO) G-463A (rs2333227) genetic variants and GDM in 719 patients with GDM and 1205 control women. Clinical, metabolic, and oxidative stress parameters were analyzed. We found that frequencies of the A allele (15.6% vs 12.3%) and GA + AA genotype (28.5% vs 23.2%) of the MPO G-463A variation were significantly higher in patients with GDM than in the control women (OR = 1.318, 95% CI: 1.068-1.625, P = 0.010 for the dominant model; OR = 1.999, 95% CI: 1.040-3.843, P = 0.034 for the recessive model; OR = 1.320, 95% CI: 1.095-1.591, P = 0.004 for the allele model). Genotype GA + AA remained a significant predictor of GDM in a logistic regression model including age and BMI at delivery (OR = 1.282, 95% CI: 1.037‒1.583, P = 0.021). Furthermore, the ‒463A allele was associated with higher TG and the 242T allele was related to higher pre-pregnancy BMI and oxidative stress index in all subjects (P < 0.05). The 242T allele was also associated with higher homeostatic model assessment of insulin resistance but lower serum total antioxidant capacity in patients with GDM (P < 0.05). We conclude that the MPO G-463A, but not the CYBA C242T, genetic variation is associated with an increased risk of GDM in Chinese women. These two genetic polymorphisms may be linked to obesity, dyslipidemia, insulin resistance, and oxidative stress.

Association Between Maternal Health Status and Family Resilience: Results from a National Survey

OBJECTIVE

The relationship between maternal health and health outcome of offspring has been studied extensively. However, measures such as family resilience in the context of maternal health are not well understood. The objective of this study was to determine if overall maternal health status is associated with family resilience.

METHODS

Using the 2016 National Survey of Children's Health, a nationally representative survey of parents/guardians of children ages 0-17, we evaluated the association of overall maternal health status with measures of family resilience. The analysis was performed using descriptive and multivariable analyses. The study adjusted for current health insurance status, family structure of child's household, income level, highest education of adult in household, child race, primary household language, children with special health care needs, emotional support, neighborhood support, parental aggravation, and adverse childhood experiences.

RESULTS

Compared to mothers who reported their physical health to be good, mothers who had a very good/excellent physical health status reported significantly higher adjusted rates for family resilience measures [Adjusted Odds Ratio (AOR) 0.741, 95% Confidence Interval (CI) (0.640, 0.859); p < 0.001]. Results suggested also that mothers whose mental health was very good/excellent were more likely to exhibit greater family resilience as compared to those that were good [(AOR) 0.452, 95% (CI) (0.390, 0.525); p < 0.001] or poor/fair [(AOR) 0.283, 95% (CI) (0.223, 0.360); p < 0.001].

CONCLUSION

Our findings suggest that maternal mental and physical health may contribute to how families respond to adversity. Our findings highlight the importance of evaluating interventions that target both physical and mental aspects of maternal health status to better the resilience of the family unit. In the healthcare setting, maternal health services should ensure early detection and prevention of chronic conditions beyond obstetric care and detection and treatment of mental health.

Role of the Gut Microbiota in the Increased Infant Body Mass Index Induced by Gestational Diabetes Mellitus

The connection between gestational diabetes mellitus (GDM) and the offspring's development, such as obesity, is well established. Emerging evidence indicates that the microbiota of the neonate's meconium is associated with maternal GDM status. To explore whether the association between GDM and infant body mass index (BMI) in early childhood is affected by the meconium microbiota, we recruited 120 mothers (60 healthy women and 60 with GDM) and their newborns from the Women's Hospital of Nanjing Medical University. Meconium of 120 neonates was collected within a few hours after birth and sequenced using 16S rRNA sequencing analysis. Children's BMI was measured at 12 months of age. The results revealed that infants born to mothers with GDM had increased BMI Z-scores at 12 months old and that the β-diversity of their meconium microbiota was reduced. Several genera were observed to be significantly different between the GDM and control groups. The genus Burkholderia-Caballeronia-Paraburkholderia and an untitled genus in the family Enterobacteriaceae enriched in neonates born to healthy mothers were found to be negatively associated with infant BMI by using regression analysis. A coabundance group depleted in the GDM group was correlated negatively with 12-month BMI and mediated 21.65% of the association between GDM and infant BMI by mediation analyses. This study provided evidence for the associations among maternal GDM, the meconium microbiota, and infant BMI. Maternal GDM was demonstrated to affect infant BMI, mediated by the gut microbiome. Gut microbiome interventions might represent a novel technique to decrease the risk of GDM-induced childhood obesity. IMPORTANCE Using 16S rRNA sequencing analysis, regression analysis and mediation analysis were used to explore whether maternal gestational diabetes mellitus (GDM) changed the function and composition of the meconium microbiota and whether this explained the GDM-induced alterations of infant body mass index (BMI). This study showed that gut microbiome dysbiosis induced by maternal GDM might play an important role in the increased infant BMI during the first 12 months of life. Therefore, gut microbiome interventions might represent a novel technique to decrease the risk of GDM-induced childhood obesity.

Effect of Dietary Intervention Designed with Behavior Change Wheel on Compliance with Dietary Control in Women with Gestational Diabetes Mellitus: Study Protocol for a Randomized Controlled Trial

BACKGROUND AND PURPOSE

Previous studies have shown that women with GDM can benefit from following dietary recommendations, which are based on food exchange serving (FES) and glycemic load (GL), but compliance with dietary recommendations in women with GDM is not ideal. Therefore, the aim of this paper is to design a dietary intervention program based on behavior change wheel (BCW) to affect GDM women's compliance with FES based on GL, and to compare the effects of this dietary intervention program versus general dietary management on compliance with dietary recommendations, improving maternal glucose metabolism, and reducing adverse pregnancy outcomes in women with GDM.

METHODS

This paper is a methodological description of a two-arm randomized controlled trial. In this study, eligible women with GDM will be recruited and divided into the control group (n = 30) and the intervention group (n = 30). Women with GDM will respectively receive general dietary management (control group) and dietary intervention designed with BCW (intervention group) until after delivery. Information about pregnant women will be collected through questionnaires or prenatal and delivery records.

CONCLUSION

This randomized controlled trial is designed specifically for women with GDM to achieve effective blood glucose control by strengthening GDM women's compliance with dietary recommendations. If this dietary intervention designed with BCW proves to be effective, then BCW may deserve to be applied to more areas of self-management in women with GDM.

Appropriate neck/waist circumference cut-off points for gestational diabetes prediction in Iranian pregnant women: The baseline analysis of the Qazvin maternal and neonatal metabolic study (QMNMS), Iran

BACKGROUND

Gestational diabetes is the most common complication during pregnancy and it is essential to identify the high-risk groups for gestational diabetes mellitus (GDM) in the first trimester. A large neck circumference (NC) in the first trimester is a measure of obesity.

OBJECTIVE

The present study investigated whether pregnant women's first-trimester NC and waist circumference (WC) measurements present a predictive index for GDM diagnosis.

MATERIALS AND METHODS

This longitudinal cohort study was conducted on 676 pregnant women aged ≥20 years. Pregnant women at 12-14th (baseline) gestational weeks underwent measurement of neck and other anthropometric indices. GDM was diagnosed with 75-g oral glucose tolerance test at 24-28th gestational week.

RESULTS

GDM was developed in 110 (16.3%) pregnant women. The logistic regression analysis showed that baseline NC > 33.5 cm (OR: 2.037, 95% CI: 1.313-3.161; P = 0.002) and WC > 90.5 (OR: 2.299, 95% CI: 1.510-3.501; p < 0.001) were independent predictors of GDM. The area under the receiver operating characteristic (ROC) curve analysis of baseline NC and WC for GDM prediction respectively yielded 0.614 (95% CI: 0.558-0.670, p < 0.001) and 0.641 (CI: 0.583-0.698, p < 0.001). The optimal cut-off level of maternal baseline NC was >33.5 cm, with 68.5% sensitivity and 48.3% specificity, and for baseline WC it was >90.5.50 cm, with 57% sensitivity and 63.4% specificity.

CONCLUSION

Pregnant women with an NC > 33.5 cm and a WC > 90.5 cm at baseline (12-14th gestational weeks) had a higher chance of developing GDM. first-trimester NC and waist circumference (WC) measurements present a predictive index for GDM diagnosis.

Associations of Gestational Diabetes Mellitus and Excessive Gestational Weight Gain with Offspring Obesity Risk

OBJECTIVE

Gestational diabetes mellitus (GDM) and gestational weight gain (GWG) are important risk factors that are known to affect offspring growth, but these outcomes are inconsistent and it remains unknown if both risk factors have a synergetic effect on early childhood growth. The present study aimed to conduct offspring body mass index-for-age Z-scores (BMIZ) trajectories and to evaluate the independent and interactive effect of the status of GDM and excessive GWG on the risks of overweight/obesity from birth to 24 months of age.

METHODS

A total of 7949 mother-child pairs were enrolled in this study. The weight and length of children were measured at birth, 6, 12, and 24 months of age to calculate BMIZ.

RESULTS

The status of GDM was positively associated with offspring BMIZ and risk of macrosomia at birth but was not associated with offspring BMIZ or the risks of overweight/obesity at 6, 12, and 24 months of age. In contrast, excessive GWG was positively linked to offspring BMIZ, the stable high BMIZ trajectory pattern, and risks of overweight/obesity in the first 24 months of age. These two risk factors also had a significant synergistic effect on macrosomia at birth, but the interactive effect was only significant in boys during the follow-up years in the sex-stratified analyses.

CONCLUSION

The maternal GWG was a more pronounced predictor than GDM with relation to BMIZ and risk of overweight/obesity in early childhood. The interactive effect between these risk factors on offspring overweight/obesity may vary by sex.

Association of maternal obesity and gestational diabetes mellitus with overweight/obesity and fatty liver risk in offspring

BACKGROUND

Childhood obesity and fatty liver are associated with adverse outcomes such as diabetes, metabolic syndrome, and cardiovascular diseases in adulthood. It is very important to identify relevant risk factors and intervene as early as possible. At present, the relationship between maternal and offspring metabolic factors is conflicting.

AIM

To estimate the association of maternal obesity and gestational diabetes mellitus (GDM) with overweight/obesity and fatty liver risk in offspring at 8 years of age.

METHODS

The prospective study included mothers who all had a 75-g oral glucose tolerance test at 24-28 wk of gestation and whose offspring completed follow-up at 8 years of age. Offspring birth weight, sex, height, weight, and body mass index (BMI) were measured and calculated. FibroScan-502 examination with an M probe (Echosens, Paris, France) was prospectively conducted in offspring aged 8 years from the Shanghai Prenatal Cohort Study.

RESULTS

A total of 430 mother-child pairs were included in the analysis. A total of 62 (14.2%) mothers were classified as obese, and 48 (11.1%) were classified as having GDM. The mean age of the offspring at follow-up was 8 years old. Thirty-seven (8.6%) offspring were overweight, 14 (3.3%) had obesity, and 60 (14.0%) had fatty liver. The prevalence of overweight, obesity and fatty liver in offspring increased significantly across maternal BMI quartiles (all P < 0.05). Among offspring of mothers with GDM, 12 (25.0%) were overweight, 4 (8.3%) were obese, and 12 (25.0%) had fatty liver vs. 25 (6.5%), 10 (2.6%) and 48 (12.6%), respectively, for offspring of mothers without GDM (all P < 0.05). In multiple logistic regression, after adjustment for variables, the OR for fatty liver in offspring was 8.26 (95%CI: 2.38-28.75) for maternal obesity and GDM.

CONCLUSION

This study showed that maternal obesity can increase the odds of overweight/obesity and fatty liver in offspring, and GDM status also increases the odds of overweight/obesity in offspring. Weight management and glycemic control before and during pregnancy need to be highlighted in primary prevention of pediatric obesity and fatty liver.

Prevention of gestational diabetes in pregnant women with obesity: protocol for a pilot randomised controlled trial

BACKGROUND

Obesity in pregnancy increases the risk of gestational diabetes mellitus (GDM) and associated adverse outcomes. Despite metabolic differences, all pregnant women with obesity are considered to have the same risk of developing GDM. Improved risk stratification is required to enable targeted intervention in women with obesity who would benefit the most. The aim of this study is to identify pregnant women with obesity at higher risk of developing GDM and, in a pilot randomised controlled trial (RCT), test feasibility and assess the efficacy of a lifestyle intervention and/or metformin to improve glycaemic control.

METHODS

Women aged 18 years or older with a singleton pregnancy and body mass index (BMI) ≥ 30kg/m² will be recruited from one maternity unit in London, UK. The risk of GDM will be assessed using a multivariable GDM prediction model combining maternal age, mid-arm circumference, systolic blood pressure, glucose, triglycerides and HbA1c. Women identified at a higher risk of developing GDM will be randomly allocated to one of two intervention groups (lifestyle advice with or without metformin) or standard antenatal care. The primary feasibility outcomes are study recruitment, retention rate and intervention adherence and to collect information needed for the sample size calculation for the definitive trial. A process evaluation will assess the acceptability of study processes and procedures to women. Secondary patient-centred outcomes include a reduction in mean glucose/24h of 0.5mmol/l as assessed by continuous glucose monitoring and changes in a targeted maternal metabolome, dietary intake and physical activity. A sample of 60 high-risk women is required.

DISCUSSION

Early risk stratification of GDM in pregnant women with obesity and targeted intervention using lifestyle advice with or without metformin could improve glucose tolerance compared to standard antenatal care. The results from this feasibility study will inform a larger adequately powered RCT should the intervention show trends for potential effectiveness.

TRIAL REGISTRATION

This study has been approved by the NHS Research Ethics Committee (UK IRAS integrated research application system; reference 18/LO/1500). EudraCT number 2018-000003-16 .

Foetal hyperinsulinaemia and increased fat mass correlate negatively with circulating fatty acid concentrations in neonates of gestational diabetic mothers with dietary-controlled glycaemia

BACKGROUD

Higher accretion of prenatal fat is associated with a higher proportion of obesity in children. However, most of the data on regulatory factors involved in fetal adipogenesis come from animal studies; in humans there is no evidence on how fetal insulin affects fatty acid concentrations and fetal adiposity.

OBJECTIVE

We evaluate the relationship between fetal adipose tissue accretion with insulin and fetal consumption of circulating fatty acid (FA).

METHODS

In fasting maternal blood at term and cord samples, from 41 gestational diabetes mellitus women (GDM) and 68 non-diabetic controls, serum compounds were determined. Individual FA were analyzed and expressed as concentrations of FA (mmol/L).

RESULTS

Both groups had similar maternal serum glucose, insulin, triacylglycerol (TAG), non-esterified FA (NEFA), glycerol and leptin concentrations, but most individual maternal serum FA were lower in GDM than controls. Neonatal fat mass (FM) was higher in the GDM group even though neonatal birth weights were similar. In GDM cord serum glucose, insulin, NEFA and leptin were higher than controls, but glycerol and all individual FA were lower. In GDM neonates only, a negative correlation was found between each FA and FM, and there was a strong negative correlation between the concentrations of umbilical blood insulin and five major FA.

CONCLUSION

Our results show for the first time that hyperinsulinemia in fetuses of GDM women increases FA utilization, which may contribute to to their increased adiposity.

Metabolomic profiling of stool of two-year old children from the INSIGHT study reveals links between butyrate and child weight outcomes

BACKGROUND

Metabolomic analysis is commonly used to understand the biological underpinning of diseases such as obesity. However, our knowledge of gut metabolites related to weight outcomes in young children is currently limited.

OBJECTIVES

To (1) explore the relationships between metabolites and child weight outcomes, (2) determine the potential effect of covariates (e.g., child's diet, maternal health/habits during pregnancy, etc.) in the relationship between metabolites and child weight outcomes, and (3) explore the relationship between selected gut metabolites and gut microbiota abundance.

METHODS

Using ¹ H-NMR, we quantified 30 metabolites from stool samples of 170 two-year-old children. To identify metabolites and covariates associated with children's weight outcomes (BMI [weight/height² ], BMI z-score [BMI adjusted for age and sex], and growth index [weight/height]), we analysed the ¹ H-NMR data, along with 20 covariates recorded on children and mothers, using LASSO and best subset selection regression techniques. Previously characterized microbiota community information from the same stool samples was used to determine associations between selected gut metabolites and gut microbiota.

RESULTS

At age 2 years, stool butyrate concentration had a significant positive association with child BMI (p-value = 3.58 × 10^-4 ), BMI z-score (p-value = 3.47 × 10^-4 ), and growth index (p-value = 7.73 × 10^-4 ). Covariates such as maternal smoking during pregnancy are important to consider. Butyrate concentration was positively associated with the abundance of the bacterial genus Faecalibacterium (p-value = 9.61 × 10^-3 ).

CONCLUSIONS

Stool butyrate concentration is positively associated with increased child weight outcomes and should be investigated further as a factor affecting childhood obesity.

Increasing trend in the prevalence of gestational diabetes mellitus in Taiwan

AIMS/INTRODUCTION

Maternal hyperglycemia leads to adverse pregnancy outcomes, and also subsequently affects both mothers and their offspring in later life. The prevalence of type 2 diabetes mellitus is increasing worldwide, and gestational diabetes mellitus (GDM) is also believed to be increasing. More precise nationwide and up-to-date data on GDM are required.

MATERIALS AND METHODS

A population-based retrospective cohort study was carried out with the Birth Certificate Application database and linked to the National Health Insurance Research Database to explore trends in the annual crude prevalence of GDM in all women who gave birth between 1 January 2004 and 31 December 2015 in Taiwan and their pregnancy outcomes. The registry is considered complete, reliable and accurate.

RESULTS

A total of 2,468,793 births from 2,430,307 pregnancies were reported between 1 January 2004 and 31 December 2015. Finally, 2,053,305 pregnancies were included for further analysis. The annual prevalence of GDM increased by 1.8-fold during the 12 years from 2004 to 2015, with a significant continuous increasing trend (from 7.6% to 13.4%, P < 0.001). The annual prevalence of GDM significantly increased in each age group (all trends P < 0.001), particularly for women with maternal ages of 31 years and older. Urbanization level, geographic risk factors and seasonal variations were also noted.

CONCLUSION

The annual prevalence of GDM increased by 1.8-fold in the 12-year period from 2004 to 2015 in Taiwan, with a significant continuous increasing trend (from 7.6% to 13.4%, P < 0.001).

Novel epigenetic link between gestational diabetes mellitus and macrosomia

Background & objectives: Examine maternal gestational diabetes mellitus (GDM), macrosomia and DNA methylation in candidate genes IGF1, IGF2, H19, ARHGRF11, MEST, NR3C1, ADIPOQ and RETN. Materials & methods: A total of 1145 children (572 GDM cases and 573 controls) from the Tianjin GDM study, including 177 with macrosomia, had blood DNA collection at median age 5.9 (range: 3.1-10.0). We used logistic regression to screen for associations with GDM and model macrosomia on 37 CpGs, and performed mediation analysis. Results: One CpG was associated with macrosomia at false discovery rate (FDR) <0.05 (cg14428359 in MEST); two (cg19466922 in MEST and cg26263166 in IGF2) were associated at p < 0.05 but mediated 26 and 13%, respectively. Conclusion: MEST and IGF2 were previously identified for potential involvement in fetal growth and development (Trial Registration number: NCT01554358 [ClinicalTrials.gov]).

Obesity and adiposity of 3- to 6-year-old children born to mothers with hyperglycaemia first detected in pregnancy in an urban South African setting

BACKGROUND

Understanding the association between maternal metabolic conditions in pregnancy and the risk of childhood overweight, a growing concern in sub-Saharan Africa (SSA), helps to identify opportunities for childhood obesity prevention.

AIM

To assess the association between hyperglycaemia first detected in pregnancy (HFDP) (gestational diabetes mellitus [GDM] and diabetes in pregnancy [DIP]) and child obesity and adiposity in pre-school-aged children in South Africa, independently of maternal BMI.

SUBJECTS AND METHODS

Measurement of anthropometry and fat mass index (FMI) by the deuterium dilution method was done for 102 3-6-year-old children born to mothers with HFDP and 102 HFDP-unexposed children. Hierarchical regression analysis and generalised structural equation modelling (GSEM) were performed.

RESULTS

The prevalence of overweight/obesity was 10.5% and 11.1% in children exposed to GDM and DIP, respectively, and 3.9% in the HFDP-unexposed group. Log-transformed FMI was significantly higher in the DIP-exposed group (β = 0.166, 95% CI = 0.014-0.217 p= .026), but not when adjusting for maternal pregnancy BMI (β = 0.226, 95% CI = 0.003-0.015, p = .004). GSEM showed significant total effects of maternal BMI and birth weight on FMI/BMI.

CONCLUSIONS

Maternal pregnancy BMI seems to play a greater role in the development of childhood adiposity than maternal hyperglycaemia, requiring further research and identifying maternal BMI as a relevant prevention target in our setting.

Trends in prevalence of gestational diabetes mellitus in Zhejiang Province, China, 2016-2018

Background

Limited population-based studies have investigated the secular trend of prevalence of gestational diabetes mellitus (GDM) in mainland China. Therefore, this study aimed to estimate the prevalence of GDM and time trends in Chinese female population.

Methods

Based on Diabetes Surveillance System of Zhejiang Province, 97,063 diagnosed GDM cases aged 20–50 years were identified from January 1, 2016 to December 31, 2018. Annual prevalence, prevalence rate ratios (PRRs) and average annual percentage change with their 95% confidence intervals (CIs) were reported.

Results

The age-standardized overall prevalence of GDM was reported to be 7.30% (95% CI 7.27–7.33%); 9.13% (95% CI 9.07–9.19%) in urban areas and 6.24% (95% CI 6.21–6.27%) in rural areas. Compared with 20–24 years age group, women in advanced age groups (25–50 years) were at higher risk for GDM (PRRs ranged from 1.37 to 8.95 and the 95% CIs did not include the null). Compared with rural areas, the risk for GDM was higher in urban areas (PRR: 1.69, 95% CI 1.67–1.72). The standardized annual prevalence increased from 6.02% in 2016 to 7.94% in 2018, with an average annual increase of 5.48%, and grew more rapidly in rural than urban areas (11.28% vs. 0.00%).

Conclusions

This study suggested a significant increase in the prevalence of GDM among Chinese female population in Zhejiang province during 2016–2018, especially in women characterized by advanced age and rural areas.

Prenatal gestational diabetes mellitus exposure and accelerated offspring DNA methylation age in early childhood

Background: We investigated the association between prenatal GDM exposure and offspring DNA methylation (DNAm) age at 3-10 years of age in the Tianjin GDM Observational Study. Methods: This study included 578 GDM and 578 non-GDM mother-child pairs. Children underwent an exam with anthropometric measurements and blood draw for DNAm analysis (Illumina 850 K array) at a median age of 5.9 years (range 3.1-10.2). DNAm age was calculated using two epigenetic clock algorithms (Horvath and Hannum). The residual resulting from regressing DNAm age on chronological age was used as a metric for age acceleration. Results: Chronological age was positively correlated with Horvath DNAm age (r = 0.53, p < 0.0001) and Hannum DNAm age (r = 0.38, p < 0.0001). Offspring age acceleration was higher in the GDM group than non-GDM group after adjustment for potential confounders (Horvath: 4.96 months higher, adjusted for sex, pre-pregnancy BMI, cell-type proportions, and technical bias, p = 0.0002; Hannum: 11.2 months higher, adjusted for cell-type proportions and technical bias, p < 0.0001). Increased offspring DNAm age acceleration was associated with increased offspring weight-for-age Z-score, BMI-for-age-Z-score, waist circumference, body fat percentage, subscapular skinfold, suprailiac skinfold, upper-arm circumference, and blood pressure; findings were stronger in the GDM group. Conclusions: We found that offspring of women with GDM exhibit accelerated epigenetic age compared to control participants, independent of other maternal factors. Epigenetic age in offspring was associated with cardiometabolic risk factors, suggesting that GDM and GDM-associated factors may have long-term effects on offspring epigenetic age and contribute to health outcomes.

Maternal GDM Status, Genetically Determined Blood Glucose, and Offspring Obesity Risk: An Observational Study

OBJECTIVE

The purpose of this study was to estimate the associations of genetically determined maternal blood glucose levels with obesity-related outcomes among children from pregnancies with and without gestational diabetes mellitus (GDM).

METHODS

A total of 1,114 mothers with (N = 560) and without (N = 554) GDM and their children were included in the present study. A maternal genetic risk score (GRS) for blood glucose was constructed on the basis of 17 single-nucleotide polymorphisms identified from a recent genome-wide association study.

RESULTS

It was found that maternal GRS for blood glucose showed different associations with offspring risk of overweight and obesity, as well as adiposity measures (all P _{for interaction}  < 0.05). Among mothers without GDM, genetically determined maternal blood glucose levels were associated with an 89% higher risk of overweight in their children (95% CI: 42%-152% per SD increase in GRS, P = 1.40 × 10^-5 ) and a 120% higher risk of obesity (44%-235%, P = 2.61 × 10^-4 ) after adjustment for covariates. In addition, higher maternal GRS for blood glucose was associated with children's increased obesity-related traits (all P < 0.05). However, no significant associations were observed among children of mothers with GDM.

CONCLUSIONS

This study indicates that GDM status may modify the relation between genetically determined glucose levels and obesity risk among children.

Qualitative study on public health nurses' experience and assessment of nutritional and physical activity counseling of women with gestational diabetes

INTRODUCTION

The number of pregnant women with gestational diabetes mellitus (GDM) has increased worldwide. GDM is a known risk factor for pregnant mothers and their fetuses that may increase various complications and health concerns. Nutrition and physical activity (PA) counseling during pregnancy can be crucial in supporting pregnant women to adopt healthier lifestyle practices and reducing these risks. This study describes public health nurses’ (PHNs) experiences of nutrition and PA counseling and their assessments on how to develop the counseling for pregnant women with GDM.

METHODS

This is a descriptive qualitative study containing theme-interviews of 11 PHNs working in an antenatal maternity care setting. The data were analyzed using inductive content analysis.

RESULTS

Five main themes were identified related to PHNs’ experiences and assessment of nutrition and PA counseling for pregnant women with GDM: competency of nutrition and PA counseling, challenges of counseling, positive experiences of counseling, printed material, and counseling practices. PHNs considered nutrition and PA counseling both challenging and rewarding. There was lack of knowledge and skills to provide proper counseling and adequate material to support versatile counseling.

CONCLUSIONS

Material related to nutrition and PA counseling should be updated and standardized. PHNs need further training to improve knowledge in the area of diet and exercise.

Maternal Gestational Diabetes Mellitus Modifies the Relationship Between Genetically Determined Body Mass Index During Pregnancy and Childhood Obesity

OBJECTIVE

To analyze the interactions between maternal gestational diabetes mellitus (GDM) and genetically determined maternal body mass index (BMI) during pregnancy on offspring childhood obesity.

RESEARCH DESIGN AND METHODS

A total of 1114 Chinese mother-child pairs (560 GDM and 554 non-GDM) were included between August 2009 and July 2011. Maternal genetic risk score (GRS) of BMI during pregnancy was derived on the basis of 12 single nucleotide polymorphisms identified from a genome-wide association study. Offspring's BMI, BMI-for-age z score, weight, weight-for-age z score, waist circumference, sum of skinfolds, and body fat percentage during childhood were measured or calculated.

RESULTS

Maternal GRS of BMI during pregnancy significantly interacted with maternal GDM status on childhood risks of overweight and obesity (all P for interaction <.05). After multivariable adjustment, per unit of GRS was associated with a 24% (P<.001) and a 28% (P<.001) increased risk of overweight and obesity among children of GDM mothers, whereas no significant associations were observed among children of mothers without GDM. In addition, per unit GRS of BMI during pregnancy was significantly associated with 0.16 kg/m² higher BMI (P=.002), 0.09 higher BMI-for-age z score (P=.002), 0.24 kg higher weight (P=.04), 0.06 higher weight-for-age z score (P=.02), 0.28 cm higher waist circumference (P=.03), 0.94 mm higher sum of skinfolds (P=.004), and 0.37% higher body fat percentage (P=.03) among children of GDM mothers. There were no significant associations between maternal GRS of BMI during pregnancy and offspring's obesity-related outcomes among children of mothers without GDM.

CONCLUSION

Our findings for the first time indicate that maternal GDM status may modify the relation between genetically determined maternal BMI during pregnancy and offspring's obesity risk during childhood.

Maternal MTNR1B genotype, maternal gestational weight gain, and childhood obesity

BACKGROUND

Maternal metabolic abnormalities have been related to offspring obesity especially during childhood.

OBJECTIVES

We analyzed whether the gestational diabetes mellitus (GDM)-associated melatonin receptor 1B (MTNR1B) genotype of mothers modified the relation between maternal gestational weight gain and childhood obesity.

METHODS

A total of 1114 Chinese mother-child pairs (mothers with or without prior GDM) were included. Mothers' MTNR1B rs10830962 genotype and gestational weight gain were assessed. Indicators of childhood obesity included BMI-for-age z-score, weight-for-age z-score, waist circumference, and body fat. Childhood overweight and obesity were also analyzed.

RESULTS

We found that the maternal MTNR1B genotype significantly interacted with gestational weight gain on indicators of offspring's obesity (all P for interaction < 0.05). After multivariable adjustment, BMI-for-age z-scores associated with 1-kg gestational weight gain were 0.009 (SE 0.018), 0.026 (SE 0.010), and 0.061 (SE 0.010) in children with the maternal MTNR1B genotype CC, CG, and GG, respectively (P-interaction = 0.012). Similar interactions were observed for weight-for-age z-score, waist circumference, and body fat (P-interaction = 0.001, 0.003, and 0.012, respectively). The associations remained consistently significant in women with and without GDM. We also found significant interactions between the maternal MTNR1B genotype and gestational weight gain on the offspring's childhood overweight and obesity (P-interaction = 0.005 and 0.026, respectively).

CONCLUSIONS

The maternal MTNR1B genotype might interact with gestational weight gain on offspring's obesity risk during childhood.

The Sex Specific Association Between Maternal Gestational Diabetes and Offspring Metabolic Status at 1 Year of Age

Previous studies showed the association between maternal GDM and long-term effects of overweight in offspring. However, the nature of this association in the early postnatal period is still undetermined. The aim of this prospective cohort study was to evaluate whether maternal GDM is associated with overweight and obesity status in offspring at age 1 year. We studied 1167 infants born at a large obstetrical care hospital including 778 normal glucose tolerance (NGT) and 389 GDM pregnancies, matched in a 1:2 ratio according to offspring's gender, during the years 2016-2017. Overweight and obesity status in offspring of both groups were evaluated at 1 year of age through questionnaires. Infant outcomes were defined according to the WHO Child Growth Standards based on the length-based BMI-for-age. Female offspring from the GDM group exhibited a higher mean BMI (17.2 vs. 16.6, p < 0.01), a higher rate of obesity (13.9% vs. 7.7%; p < 0.05), and overweight (33.1% vs. 23.5%; p < 0.05) as compared to the NGT female group. In the multivariable regression model, maternal GDM was found to be independently and significantly associated with overweight or obesity in 1-year aged female offspring only (OR 1.61, 95% CI 1.09-2.37, p < 0.05). We found a sex specific association between maternal GDM and the overweight risk only in female offspring at 1 year of age.

Hyperglycemia During Pregnancy and Long-Term Offspring Outcomes

PURPOSE OF REVIEW

This review will focus on the long-term outcomes in offspring exposed to in utero hyperglycemia and gestational diabetes (GDM), including obesity, adiposity, glucose metabolism, hypertension, hyperlipidemia, nonalcoholic fatty liver disease, and puberty.

RECENT FINDINGS

There is evidence, mostly from observational studies, that offspring of GDM mothers have increased risk of obesity, increased adiposity, disorders of glucose metabolism (insulin resistance and type 2 diabetes), and hypertension. In contrast, evidence from the two intervention studies of treatment of mild GDM and childhood measures of BMI, adiposity, and glucose tolerance do not demonstrate that GDM treatment significantly reduces adverse childhood metabolic outcomes. Thus, more evidence is needed to understand the impact of maternal GDM on offspring's adiposity, glucose metabolism, lipid metabolism, risk of fatty liver disease, and pubertal onset. Offspring of GDM mothers may have increased risk for metabolic and cardiovascular complications. Targeting this group for intervention studies to prevent obesity and disorders of glucose metabolism is one potential strategy to prevent adverse metabolic health outcomes.

Maternal Gestational Diabetes Is Associated With Offspring's Hypertension

OBJECTIVE

Several studies assessed maternal gestational diabetes mellitus (GDM) with the risk of childhood high blood pressure, and the results were inconsistent. We investigated the association between maternal GDM and hypertension risk in offspring during early childhood.

METHODS

We performed a large study in 1,156 mother-child pairs (578 GDM and 578 non-GDM matched by their offspring's age and sex). Maternal GDM was diagnosed according to the World Health Organization criteria. Childhood height, weight, and blood pressure were measured using standardized methods. Age-, sex-, and height-specific blood pressure Z score, childhood hypertension, and high blood pressure were evaluated according to the reference range of the National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents.

RESULTS

After adjustment for maternal and children's characteristics, children born to mothers with GDM during pregnancy had higher mean values of systolic blood pressure Z score (0.09 vs. -0.17), and higher prevalence of hypertension (6.4% vs. 3.5%) and high blood pressure (15.6% vs. 9.3%) in comparison with their counterparts born to mothers without GDM during pregnancy (all P values <0.05). Multivariable-adjusted odds ratios among children of mothers with GDM compared with children of mothers without GDM were 2.32 (95% confidence intervals [CI] 1.16-4.62) for hypertension and 1.89 (95% CI 1.24-2.86) for high blood pressure, respectively.

CONCLUSIONS

Maternal GDM was associated with an increased risk of hypertension in the offspring. Controlling maternal GDM may be important for preventing childhood hypertension in the affected offspring.